Franke Katharina, Lüdemann Monika, Gonzalez Y Gonzalez Maria B
Kinderherzzentrum und Zentrum angeborene Herzfehler, Universitätsklinikum Gießen und Marburg, Standort Gießen, Feulgenstraße 10-12, 35385, Gießen, Deutschland.
Herzschrittmacherther Elektrophysiol. 2024 Dec;35(4):327-333. doi: 10.1007/s00399-024-01037-7. Epub 2024 Sep 3.
In patients with congenital heart disease, cardiac arrhythmias are complex and require a thorough understanding of the anatomy, past surgical and interventional procedures, and the specific electric processes. Supraventricular tachycardias commonly present as emergency situations and should be treated immediately, particularly when there is an underlying complex malformation. Establishing sinus rhythm is usually superior to pure frequency control for hemodynamic reasons. Catheter ablation should be preferred over medical treatment, even though several procedures are often necessary. In addition, bradycardia is seen more frequently in congenital heart defects; this could be aggravated by antiarrhythmic drugs. There are significant differences between the indications and techniques used for pacemaker implantation in patients with congenital heart defects and those without. Patients with complex congenital heart diseases have an increased risk of thromboembolism; therefore, an individual and early indication for low-threshold oral anticoagulation is necessary; direct oral anticoagulants can also be used for this purpose. In risk stratification for sudden cardiac death, the principles of general guidelines are often not applicable, and individualized decisions are required. Recently, a new general risk score for congenital heart disease has been developed. The treatment of cardiac arrhythmias in patients with congenital heart disease should always be performed in close cooperation with specialized centers.
在先天性心脏病患者中，心律失常情况复杂，需要全面了解其解剖结构、既往手术和介入治疗过程以及具体的电生理过程。室上性心动过速通常表现为紧急情况，应立即进行治疗，尤其是在存在潜在复杂畸形的情况下。出于血流动力学原因，建立窦性心律通常优于单纯控制心率。尽管通常需要多次手术，但导管消融术应优先于药物治疗。此外，先天性心脏缺陷患者中缓慢性心律失常更为常见；抗心律失常药物可能会加重这种情况。先天性心脏缺陷患者与非先天性心脏缺陷患者在起搏器植入的适应证和技术方面存在显著差异。复杂先天性心脏病患者发生血栓栓塞的风险增加；因此，有必要针对个体尽早进行低阈值口服抗凝治疗；直接口服抗凝剂也可用于此目的。在心脏性猝死的风险分层中，一般指南的原则往往不适用，需要进行个体化决策。最近，已开发出一种新的先天性心脏病总体风险评分。先天性心脏病患者心律失常的治疗应始终与专业中心密切合作进行。
